Back pain tends to improve quickly, not completely

NEW YORK (Reuters Health) - Lower back pain often fades fairly quickly, but it may stubbornly linger to some extent for months or more, a new study finds.

"The clear good news is that if you seek care for your back pain, you do improve pretty quickly, and some folk do a lot better than others," said Christopher G. Maher, at researcher at the George Institute for Global Health in Sydney, Australia, who worked on the study.

The less-than-good news is that, on average, people with low back pain tend to still have some symptoms as much as a year later.

"Typically, back pain is a long-term, recurrent condition, so a quick fix is not realistic for most people," Maher told Reuters Health in an email.

Nearly everyone goes through a bout of low back pain at some point. In the U.S., people spend at least $50 billion a year on treating the problem, according to the National Institutes of Health.

Back aches may last for just a few days or weeks in some cases. But for other people, the pain is more stubborn; low back pain that lasts three months or more is considered chronic or "persistent."

In their study, Maher and his colleagues found that people seeking treatment for persistent back pain were especially likely to still have symptoms a year later.

The findings, reported in the Canadian Medical Association Journal, come from an analysis of past studies on how low back pain patients fare in the "real world" of medical care.

The studies involved nearly 11,200 patients in all. Some had "acute" back pain (lasting less than three months), while others had persistent pain. But all had gone to the doctor seeking treatment.

On average, people with acute back pain scored a 52 out of 100 on a standard pain scale at the time they sought treatment. Six weeks later, that score was down to 23, and after a year, it had fallen to a 6.

People with persistent back pain fared less well. They started with an average pain score of 51, then improved to 33 after six weeks, and finally landed at 23 after a year.

Patients with either acute or persistent back pain also showed fairly quick improvements in "disability" -- such as difficulty with bending or lifting.

After a year, both groups had mild levels of disability, on average.

According to Maher, the findings suggest that people with persistent back pain should see it as a problem that requires long-term management.

"People should think of back pain as probably more like asthma or diabetes, where maintaining a health lifestyle and good self-management are important if we want to get the most from life," Maher said.

WHAT WORKS FOR BACK PAIN?

This analysis does not show what specifically works for back pain. People in the studies were on a variety of therapies.

But in general, Maher said, "we do have some information on what works for back pain."

Based on guidelines from the American College of Physicians and American Pain Society, there's "good" evidence that acute back pain can improve with over-the-counter pain killers, heat and staying active to the degree possible.

For persistent back pain, painkillers and formal exercise therapy may help. There is also evidence supporting spinal manipulation therapy and cognitive behavioral therapy -- a form of "talk therapy" where people learn behavioral tactics to manage physical symptoms.

"I think that most people with an episode of uncomplicated low back pain don't need to seek care at all," said Rachelle Buchbinder, a professor at Monash University in Malvern, Australia, who wrote an editorial published with the study.

"They can just manage it themselves, take analgesics if they need to, and continue to do their usual activities, including work," Buchbinder said in an email.

There are exceptions, however, she said. Severe pain is one.

Another would be the case of an elderly person who has no history of back pain problems; that's because low back pain can sometimes be a sign of a serious condition, such as certain cancers or a spinal fracture.

If you do see a health provider for back pain, Buchbinder said, the important thing is to make sure he or she is offering "evidence-based" care.

That may be easier said than done. But Buchbinder said you can look for some red flags that your provider is not up to speed in treating low back pain.

One would be if he or she advised you not to return to your usual activities until you are pain-free.

That is outdated advice. Experts now believe that most people with routine back pain should try to keep moving, rather than stay off their feet, Buchbinder pointed out.

In addition, she said, most people with low back pain do not need x-rays or any other type of imaging -- because it's simply not useful. So if your provider recommends imaging, ask why it's being suggested, and possibly get another opinion.